Vendor Forms

In order for a store to be authorized as a WIC vendor, an application and price sheet must be submitted, a store visit conducted by WIC staff and, if approved, an agreement signed by store management. Those forms, and others, may be downloaded from the links listed below.

Download Vendor Forms.

Request Form for WIC Warrant Electronic Reimbursement Payment

The form to be used when requesting reimbursement payment from the State of Alaska through KeyBank

Alaska WIC Vendor Application (updated: 10/12)
Apply to be a WIC vendor. Please print and submit the current Minimum Stock Requirements with your application.

Vendor Supplies Form
Supplies orderform between vendor and State of Alaska.

Vendor Contract Form
Agreement form between vendor and State of Alaska.

Vendor Monitoring Form (updated: 02/2011)
Form for on-site and after visit report.

WIC Pre-Agreement On-site Vendor Visit Report (updated: 12/12/06)
Form to fill out before visiting WIC Vendor Site.

Retraining Form (4/10)
This form may be used by vendors to notify us of a problem experienced with a client who does not seem to understand the WIC program rules or how to purchase the correct foods. It can also be used by a client to help us identify cashiers that may need additional training on WIC policies and procedures.

Alaska WIC Program Complaint Form
Form to fill out in case of complaint.

Compliance Report
WIC and Local Agency staff will use this form for conducting compliance buys at WIC vendors. Vendors should ensure their employees, especially cashiers are familiar with this form. The main reason a vendor fails a compliance buy is because a cashier fails to ask for identification; or once they ask for identification they do not hold onto the I.D. to do a side by side comparison of the signatures.